Building a framework for the study of interventions to prevent, stop or slow Alzheimer’s disease progression: where are we and where must we go? J Prev Alzheimers Dis 2020

Switching from a focus on clinical, symptomatic outcomes of severe dementia to identifying people with early pathological changes associated with risk of Alzheimer’s disease (AD) offers an opportunity to revolutionize the development of disease-modifying AD drugs. The latest edition of The Journal of Prevention of Alzheimer’s Disease (JPAD) features a themed selection of articles addressing key challenges in the study of new treatments to prevent, stop or slow the progression of Alzheimer’s disease.¹

One extensively reported topic is the need to identify trial-ready cohorts of people with pathological changes associated with AD risk to aid the search for disease-modifying drugs. This is the primary focus of the large Trial-Ready Cohort for Preclinical and Prodromal Alzheimer’s Disease (TRC-PAD) initiative in the USA. Articles in this edition of JPAD describe the aims and structure of the TRC-PAD project, including a summary of the first three years’ experience, and discuss the role of biomarkers such as amyloid burden in risk assessment.

Outcomes of interventional trials will also need to include assessment of cognitive and functional changes over time as well as measurement of blood-based biomarkers. Their established validity and ease of access will be crucial to the development and assessment of new interventions. Early data regarding their use are promising.

This edition also includes the findings from a series of reports regarding the need for early diagnosis of mild cognitive impairment (MCI) by the  Global Advisory Group on Future MCI Care Pathways. These insights highlight that early functional changes, such as MCI, require a recognized assessment framework to increase the likelihood of operating within an ‘optimal therapeutic window’, i.e., before dementia has progressed too far.

¹J Prev Alzheimers Dis 2020; 7(4)